Nicholas reports no relevant financial disclosures.
Angela M. Nicholas, MD, says that no patient she sees aged older than 45 years leaves her office without discussing cancer screening.
“It doesn’t matter if you came in for a finger cut or a complete physical,” Nicholas, a primary care provider who also serves as the medical and administrative director of Einstein Physicians Montgomery, told Healio. “We’re going to have the discussion and we’re going to keep having the discussion, because the only way that we can get people screened is to help them to understand the risks and the benefits associated with it.”
In addition to her underlying motivations as a family practice provider, Nicholas said part of her drive to increase cancer screening is personal. Her husband was diagnosed with stage IV colorectal cancer at age 45 years, passing away 5.5 years later. Without screening, Nicholas said he likely would have died much sooner.
“It’s a matter of people listening and being attentive when you hear something that doesn’t seem right,” Nicholas said. “Every American deserves to be screened for every cancer that we can screen for.
“I’ve heard that ‘mission’ is the sixth stage of grief, and it’s now my mission to make sure that every person I know is screened and every patient I come across understands and knows the facts and has an opportunity to get screened,” she added.
Colorectal cancer screening
Study data have shown that lockdowns associated with the COVID-19 pandemic led to around a 40% drop in the number of colorectal cancers diagnosed in 1 year. At the height of the pandemic, colorectal cancer screening rates were down about 90%, Nicholas said.
“The result of the pandemic is going to be felt for years to come,” she said. “The downstream effect is that patients are getting diagnosed at later stages. In general, 1 year or 2 isn’t going to make that huge a difference, but when that patient who should have had their colonoscopy never gets it, that’s the patient we see 3, 4 or 5 years from now who has now become symptomatic.”
Nicholas said that her organization has been “pretty aggressive” in getting patients to come in for makeup screenings, leading to high CMS Star Ratings across cancer types. But, in general, it has been difficult to make up for that screening backlog when new patients, in addition to those being rescheduled, also need to be seen.
“One positive thing is that lockdowns allowed us to promote the use of the in-home screening test, but because some patients need a follow-up colonoscopy, it was a real challenge to get those patients scheduled,” Nicholas said.
To increase colorectal screening rates overall, Nicholas said at-home tests, like Cologuard (Exact Sciences), provide a “fantastic opportunity” to reach patients who may be hesitant or too busy to undergo colonoscopy. Such a test is available for average-risk adults starting at age 45 years.
“People are getting back to work and back to life, and time is a precious commodity,” Nicholas said. “We’ve been successful in promoting the use of at-home screen tests to increase screening uptake. We walk them through all of the steps of receiving and returning the kit so they understand what happens next.”
Starting that discussion early is so important, considering an alarming trend showing colorectal cancer diagnoses occurring at younger ages, which last year prompted the United States Preventive Services Task Force to lower the recommended screening age from 50 to 45 years.
This trend has forced a change in mindset in the medical community, Nicholas said, although more work needs to be done to increase awareness.
“These are patients who previously we would have said, ‘Oh, it may just be hemorrhoids.’ But, in my practice, I don’t do that anymore,” she said. “Now we refer these patients to gastrointestinal doctors and they undergo colonoscopies.
“The challenge is that we need to get that message out to the community to educate everyone,” Nicholas added. “If patients think something is wrong, they need to get to a doctor who will listen to them. If they aren’t comfortable with the plan, they need to speak up. We need a medical community that’s willing to listen.”
The power to say yes
Nicholas said that she’s been fortunate to have her “passions collide” in her dual roles as a physician and an executive. Not only does she get to see and care for patients, but her experience has also enabled her to lead a physician practice group.
She admitted that some of her career trajectory involved “being in the right place at the right time,” but she also took on a variety of positions that interested her and equipped her with the skill set to serve as an executive. In addition to her clinician duties, over the years Nicholas has served as a hospital vice president, a chief medical information officer and a senior director at Siemens with a focus on electronic medical record development, among other roles.
“These different positions have enabled me to be involved with some really great projects,” Nicholas said. “It has kept my interest and added some really fun things into my day that make me want to keep doing what I do.”
Nicholas cautioned women physicians against seeking “work-life balance,” but rather to find jobs that enable flexibility for what’s important to them.
Such flexibility is what enabled to Nicholas to maintain her positions as a full-time physician and executive at a health system while caring for her husband, even if it meant working from his ICU room.
“Whether you’re single or you have a family, a spouse, or elderly parents, you have to advocate for yourself and figure out what works best for you,” Nicholas said. “There are creative ways to manage any situation and find a position that suits your needs.”
In addition to crediting female vice presidents and corporate executives who served as her mentors early on, part of Nicholas’s success has stemmed from her eagerness to try new roles.
“We hear all the time that we should be saying ‘no’ and to know our limits,” Nicholas said. “But, for me, the answer is never ‘no,’ it’s ‘yes.’ If I want to do something, how can I accomplish that? What are the things that I can take off my plate and give to someone else to let my team grow and take on more responsibility? Training someone to take your job is part of being a good leader. I try to give people as much responsibility as they can handle so that I can do more.”
Nicholas said her mantra throughout her career has been, if it stops being fun, then it’s time to find something new to do.
“If I read a job description and I think, ‘I could do that job,’ then I should apply for that job,” she said. “It’s easier to say no. It’s harder to say yes and figure out how I can make this happen. Challenges will always exist for us as women in medicine, but we should seek to continue to grow, continue to meet expectations and continue to have fun at what we do.”
For more information:
Angela M. Nicholas, MD, can be reached at email@example.com.